Primary Cutaneous Mucormycosis in an Extremely Preterm Infant Successfully Treated with Liposomal Amphotericin B

Abstract

Cutaneous mucormycosis is a rare but often fatal invasive fungal infection that occurs most commonly in patients with diabetes, malignancy, and other immunocompromising conditions. We report an extremely preterm (<28 weeks) baby boy who developed polymicrobial sepsis and primary cutaneous mucormycosis within his first 10 days of life. He was successfully treated with medical management alone since he was not a candidate for surgery. Successful treatment of cutaneous mucormycosis without surgical debridement has been reported on only two other occasions. This case highlights the importance of rapid and thorough evaluation of skin lesions when evaluating preterm infants and other immunocompromised patients, even when other sources of infection have been identified.

Primary cutaneous mucormycosis in a premature neonate treated conservatively with amphotericin B

“…4,6 Cutaneous mucormycosis infections have most commonly been reported at the sites of previous adhesive dressings, intravenous line placements, and adhesive monitors. [1][2][3]7,8 In our case, the infection developed at the previous site of an umbilical line bridge. Cases have also been reported in association with contaminated hospital linens, wound dressings, and wooden tongue depressors.…”

Expanding eschar in an immunocompromised premature infant

“…For mucormycosis infections, in this population, the mortality rate has been reported to be as high as 72% . Early diagnosis via tissue biopsy is crucial for early targeted treatment with antifungal therapy . Aspergillus and mucormycosis can be identified histologically by their branched hyphae and may be highlighted by fungal stains such as GMS.…”

“…Reported cases of aspergillosis and mucormycosis in neonates describe successful treatment with a combination of aggressive surgical debridement and amphotericin B . Systemic voriconazole has been used as an alternative in non‐responders, but there are no formal safety data on its use in premature neonates …”

“…3 Early diagnosis via tissue biopsy is crucial for early targeted treatment with antifungal therapy. [2][3][4][5][6][7] Aspergillus and mucormycosis can be identified histologically by their branched hyphae and may be highlighted by fungal stains such as GMS. Fungal culture may be useful for speciation but is often negative.…”

“…2 Reported cases of aspergillosis and mucormycosis in neonates describe successful treatment with a combination of aggressive surgical debridement and amphotericin B. [3][4][5][6][7] Systemic voriconazole has been used as an alternative in non-responders, but there are no formal safety data on its use in premature neonates. 8,9 In conclusion, extremely premature neonates with low birthweight have an underdeveloped skin barrier and an immature immune system which places them at increased risk of severe cu-…”